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Co-Existing Disease > Random Cards for Comprehensive Exam > Flashcards

Random Cards for Comprehensive Exam Flashcards

1
Q

What’s a way to get an idea of BP if no a-line and cuff is taking forever?

A

Look at EtCO2.

A sudden drop in EtCO2 would indicated a sudden drop in BP.

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2
Q

S/S of Parkinson’s treatments (Carbidopa/Levodopa)

A

Overall, think about effects of increased DA

Motor (Dyskinesias)
Psychiatric (mania, agitation, hallucunations, paranoia)
CV effects (increased contractility and HR, orthostatic hypotension)
GI (N/V d/t stimulation of CRTZ by DA)

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3
Q

Autonomic dysreflexia

A

1) Cutaneous or visceral stimulation below level of lesion
2) This activates preganglionic SNS nerves
3) Vasoconstriction below injury
4) SEVERE HTN
5) Bradycardia and vasodilation above injury

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4
Q

When is the peak risk for hyperkalemia with sux after spinal cord injury?

A

3-6 months

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5
Q

After acute head injury, the pt may experience a hyperdynamic circulatory response. S/S and tx of this

A

S/S: Increased HR, BP, and CO
Arrhythmia secondary to epi surge

Labetolol and esmolol are useful to treat this.

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6
Q

Monitors for crani for head trauma

A

All standard monitors
Probs art-line but don’t delay crani for placement!!
May or may not need CVP (to monitor hemodynamics and for VAE risk)

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7
Q

Monitoring best able to detect VAE

A

1) TEE (best)
2) Doppler
3) EtCO2

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8
Q

Isthmus of the thyroid is located over these trachial rings

A

2nd to 4th tracheal rings

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9
Q

Causes of hypoaldosteronism

A

1) Congenital deficiency

2) Hyporeninemia
- May happen in long-standing DM, renal failure, or treatment with ACE-inhibitors (causes loss of angiotensin stimulation)

3) NSAIDs
- May inhibit renin release and exacerbate existing renal insufficiency

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10
Q

S/S of Hypoaldosteronism

A

Severe hyperkalemia
Hyperkalemic acidosis
Hyponatremia
Defects in cardiac conduction

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11
Q

Treatment for hypoaldosteronism

A

Mineralcorticoids (Fludrocortisone)

Liberal salt intake

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12
Q

Nucleoside Reverse Transcriptase Inhibitors

A

N/V/D, myalgia, increased LFTs, renal toxicity, pancreatitis, peripheral neuropathies, BM suppression, anemia, lactic acidosis, and CYP450 inhibition

Zidovudine + corticosteroids = severe myopathy, including resp. muscle inpairment

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13
Q

Non-Nucleoside Reverse Transcriptase Inhibitors

A

Delavirdine= Inhibition of CYP450 and causes increased concentration of sedatives, antiarrhythmics, warfarin, and CCBs

Nevirapine induces CYP450 by 98%!

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14
Q

Protease Inhibitors

A

Ritonavir

HLD, glucose intolerance, abnormal fat distribution, altered LFTs, and CYP450 inhibition!!

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15
Q

HIV Med CYP450 Inducers and Inhibitors

A

Inhibitors:

  • Ritonavir
  • Delavirdine
  • Zidovudine

Inducer:
Nevirapine

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16
Q

Considerations for the patient on Ritonavir

A

They will have more pronounced effects with Midaz and Fentanyl (start on low end of dosing)
Ritonavir is a CYP450 inhibitor.

Avoid MAD:
Meperidine
Amiodarone

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17
Q

Most frequent S/S of TB

A 
Non-productive cough
Weight loss
Fever and night sweats
Malaise
Hemoptysis and chest pain (late s/s)
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18
Q

TB treatments and their effects

A

Most can cause hepatotoxicity (INH, rifampin, and pyrazinamide)

Rifampin is a CYP450 inducer

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19
Q

SBE Prophylaxis is Recommended in these Heart Conditions

A

1) Damaged heart valves
2) Artificial heart valves
3) Cardiac transplant pt who develops problems with heart valves
4) Hx of endocarditis
5) HCM
6) Certain congenital malformations
- Cyanotic congenital heart disease
- Congenital defect that has been repaired with artificial material for the first 6 months after the procedure
- A congenital problem that has been repaired, but has residual effects (persisting leak, etc)

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20
Q

SBE Prophylaxis is recommended in these surgical procedures

A

1) Dental or oral surgery, where perforation of the oral mucosa is likely
2) Respiratory tract surgery, where the resp. mucosa will likely be perforated
3) Procedures to treat infection of GI/GU tract, skin, or musculoskeletal tissue
4) Cardiac surgery
5) Hepatobiliary procedures with high risk of bacteremia

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21
Q

Antibiotics used for SBE prophylaxis

A

ACCC

Ampicillin, Cefazolin, Ceftriaxone, and Clindamycin

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22
Q

What is an anaphylactoid reaction?

A

A reaction that isn’t antibody-mediated
The drug itself causes histamine release from basophils. Size of reaction depends on how much of the agent was given and how rapidly.

NMBs (sux, atra, curare, and miva), opioids (morphine and demerol), and protamine can all cause this type of reaction.

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23
Q

Medications that can be used to prevent anaphylactoid reactions

A

H1 and H2 antagonists.
Corticosteroids (these cause transcription of anti-inflammatory proteins, and decrease the transcription of pro-inflammatory proteins)

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24
Q

Basically all anesthetics we give cause allergic reactions except

A

Ketamine and benzos

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25
Q

S/S of Anaphylaxis

A
  • CV collapse is often the first sign (accompanied by MI and dysrhythmias)
  • Hypotension (50% of intravascular fluid may be lost)
  • Flushing
  • Increased PIPs or difficulty ventilating (bronchospasm)
  • Difficulty intubating d/t laryngeal edema

Overall, think anaphylaxis with sudden hypotension and bronchoconstriction following drug administration

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26
Q

What should you do if your patient has an LMA in place and you suspect anaphylaxis?

A

Remove that shit and intubate!!

They will have bronchoconstriction and need assistance ventilating. If you wait, they can develop laryngeal edema and cause a difficult intubation.

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27
Q

Volume replacement in anaphylaxis

A

Colloids preferred d/t leaky capillaries

Colloid replacement: 10mL/kg
Crystalloid: 10-25mL/kg

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28
Q

Basic interventions in anaphylaxis

A

Stop offending drug
Communicate to the surgeon what is happening
Administer 100% O2
Intubate if haven’t done so already
Elevate legs
Give fluids (10-25mL/kg)
Give epinephrine (10mcg-1mg –> start low if just suspecting anaphylaxis, and see how they respond)
- If resistant to epi, try Glucagon, Norepi, or Vasopressin

Second-line pharmacology:

  • B2 agonists (albuterol and terbutaline)
  • H1&2 antagonists (better for prevention than actual treatment)
  • Corticosteroids (hydrocortisone 250mg IV)
    • -> corticosteroids work by enhancing the B effect of other agents and inhibiting arachidonic acid release
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29
Q

What is the best regional technique in the septic patient?

A

PSYCH! Regional anesthesia is contraindicated in sepsis.

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30
Q

This is the only anesthetic gas that is consistently teratogenic

A

N2O. Increases the rate of spontaneous abortions and causes birth defects.

(remember that it inhibits enzymes responsible for DNA synthesis and myelin formation)

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31
Q

Effect of gases other than N2O

A

Studies are inconclusive

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32
Q

Gas concentration standards set by NIOSH and OSHA

A

N2O less than 25ppm
Anesthetic gases < 2ppm
Both in combo < 0.5ppm

33
Q

When are you at greatest risk of VA exposure?

A

Filling the vaporizers

34
Q

Air turns over in the OR ____ times per hour

A

15-20

35
Q

When are you at greatest risk of HIV?

A

Deep cutaneous needle-stick injury with a large, hollow needle
Can also occur with small breaks in skin or splatters in mouth

36
Q

When is post-exposure anti-retroviral therapy begun after exposure?

A

<24 hours after exposure

37
Q

This virus is the most serious occupational health danger facing anesthesia providers

A

Hep B
20-50% of providers have markers of previous Heb-B exposure
Risk of infection after exposure is 37-62%
Virus can remain active up to 1 week in dried blood

38
Q

Hep C infections occur mostly due to

A

blood transfusions

39
Q

You have a ___% chance of developing TB after exposure

A

10%

40
Q

Who is most at risk of developing a latex allergy?

A

Those with chronic exposure

Spina bifida, urologic patients, and healthcare providers

41
Q

Latex allergy is often associated with these food allergies

A

Avocado, potato, banana, tomato, chestbuts, kiwi, and papaya

42
Q

WTF is methylmethacrylate?

A

Acrylic cement used for prostheses
Supplied as separate powder and liquid components that are then mixed together.
Can release toxic vapors and causes heat production.

43
Q

Risks of methylmathacrylate

A

Patient:
- Hypotension

Providers:

  • Dyspnea, wheezing, caughing, and rhinorrea
  • HTN
  • Erythema
  • HA
  • Unknown effects in pregnancy
44
Q

NIOSH recommends that 8 hour exposure to methylmethacrylate should be limited to

A

100ppm

although levels may reach 300ppm during mixing

45
Q

Effects of Sarin Gas

A

Inhibits acetylcholinesterses and butyrylcholinesterases, causing an increase in Ach in muscarinic and nitotinic receptors (effects similar to neostigmine).

Excessive secretions, bradycardia, HB, bronchospasm, sz, resp depression, and paralysis.

46
Q

Treatment for sarin gas exposure

A

1) Atropine (b/c anticholinergics are given with anticholinesterases).
2) Oximes

47
Q

Vesicant Agents (Mustard Gas)

A

These are blistering agents

Treatment: Respiratory and fluid support

48
Q

Choking agents (Chlorine gas / Phosgene)

A

Causes laryngospasm and pulmonary edema

Treatment: Respiratory support and to limit inflammation

49
Q

Cyanide. What does it do and what is the treatment?

A

It inhibits cytochrome oxidase enzymes (CYP450) and causes hypoxia.

Treatment: Sodium thiosulfate

50
Q

Botulinum Toxin. What does it do and what is the treatment?

A

Inhibits the release of Ach.

Treatment: Antiserums

51
Q

Anthrax. What does it do and what is the treatment?

A

Bacterium that causes pulmonary edema and a widened mediastinum.

Treatment: Vaccination and antibiotics (Cipro)

52
Q

Greatest risk of radiation is during

A

Fluroscopy

53
Q

Max yearly radiation exposure

A

< 5 rem

< 500mren during pregnancy

54
Q

When an x-ray is taken you should be a minimum of ___ feet away

A

3

55
Q

6 feet of air space provides the same protection from radiation as

A

9 inches of concrete or 2.5mm of lead

56
Q

Order of things to do in the event of a fire

A

ERASE

Evacuate, rescue, activate, shut doors, evaluate

57
Q

Steps in an airway fire

A

Remove the ETT
Turn off all gasses
Extinguish the fire by pouring saline down the airway
Remove any burning materials
Mask ventilate. Assess, and re-intubate.
Bronchoscopy if pieces of ETT left behind.

58
Q

Macroshocks

A

Large shocks of electricity

1mA = perception threshold
5mA = maximal harmless current
10-20mA = let-go threshold
50-100mA = pain
100-300 = Vfib, resp failure, and apnea
> 6000mA = sustained myocardial contraction, temporary resp paralysis, and burns
59
Q

Microshock

A

Direct application of a very small amount of electrical current to someone who has an external conduit that is in direct contact with the heart
(cardiac pacing wires, or invasive monitoring catheters)

  • Maximum leakage allowed is 10 micro-amprs
  • A current as low as 100 micro-amps can cause v-fib
  • A ground wire is the most important factor in preventing microshock**
60
Q

What is the line isolation monitor (LIM)?

A

A monitor that continually evaluates the integrity of the isolate power system.
It alarms at 2-5mA or resistance of 60,000 ohms.
If it detects a faulty piece of equipment, it converts to a grounded system to prevent shocks.

If it alarms, check the gauge:
2-5 means there are too many pieces of equipment plugged in
>5 means there is a faulty piece of equipment

61
Q

Type of electrocautery recommended for those with pacemakers

A

Bipolar

62
Q

Hazardous noise is considered to be

A

> 90 decibels for 8 hours/day

63
Q

Electrical power is usually (grounded/ungrounded) in the hospital

A

Ungrounded

64
Q

___% of providers will have at least one medication error or near miss in their career

A

85%

The most common error is giving relaxant instead of reversal at the end of a case.

65
Q

__% of medication errors result in death

A

1.8%

66
Q

Addiction

A

Primary, chronic disease characterized by:

  • Lack of control over drug use
  • Compulsion and craving
  • Continued use despite adverse consequences
67
Q

What is a covered entity?

A

Hospitals, dentist offices, pharmacies, health care plans, providers, clearing houses, billing services, business associates, etc.

68
Q

What is protected health information?

A

Patient health information in any form (oral, paper, electronic, or recorded).
Demographic information is also included in PHI (name, DOB, etc.)

69
Q

What is disclosed PHI?

A

PHI that is released, transferred, or accessed by anyone outside of the covered entity. Even to billing companies.

The patient must sign a release contract prior to ANY disclosure happening.

70
Q

This is included in authorization forms

A
  • Description of the PHI that will be disclosed.
  • Who the PHI is being disclosed to and why
  • If the covered entity will get financial gain from release of the info
  • Letting the pt know that they have the right to refuse authorization
  • Date and signature
71
Q

When is written authorization not required during sharing of PHI?

A
  • For the pt directory within the facility
  • When informing appropriate agencies during disasters
  • For public health issues related to disease control
  • In reporting abuse or neglect
  • For health oversight activities
  • To coroners, medical examiners, and funeral directors (b/c these people have a right to know what they’re dealing with)
  • Organ and tissue donations
  • In research, public health, or healthcare operations as a limited data set (any identifying info is removed)
72
Q

Patient rights

A
  • Patients can exercise rights over their PHI
  • Patients will receive a privacy notice at first delivery of service
  • PHI will be communicated in a way to protect confidentiality
  • Pt can inspect, amend, correct, and obtain copies of their PHI
  • Request a history of disclosures for the last 6 years (be able to see who your health info was divulged to and why)
  • Pt can contact ppl within the facility regarding concerns or breaches of confidentiality
73
Q

Parents have control over PHI of minors except when it comes to

A
  • HIV testing
  • Abuse
  • If parents agree to give control to the minor
  • If the state takes over control of the child
74
Q

These meds should be avoided in parkinson’s

A
  • Anti-emetics that are DA antagonists

- Fentanyl and alfentanil (may have some anti-DA activity)

75
Q

Loss of diaphragm functioning if injury above

A

C4

76
Q

Loss of cardiac accelerators if injury above

A

T6

77
Q

Methylprednisolone dosing within 8 hours of spinal cord injury

A

30mg/kg IV bolus, then

Infusion at 5.4mg/kg/hr for 24-48 hours

78
Q

Blood loss is greater in these areas of the spine

A

Lumbar and thoracic > cervical

Co-Existing Disease (10 decks)

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